DEAR DR. ROACH: I have some questions about my lab results. My doctor’s office called to say all results were good and everything is fine. However, when I received the printout from the lab, I read several readings that alarmed me, including a hemoglobin A1C of 5.9% (flagged as high) and glucose 114 (again flagged as high). Should my doctor have given me any suggestions to get these results under control through change of diet, etc.? What suggestions do you have? — Anon.
ANSWER: These results show you have prediabetes, which means you are at risk for developing diabetes in the future. Prediabetes itself carries additional risk for developing heart disease in the future. The standard of care now is to treat prediabetes, both to reduce cardiovascular risk as well as to prevent progression to overt diabetes. Unfortunately, I think your doctor missed an opportunity to make an intervention that could help your overall health.
As you suggest, diet is a major component of treatment. A visit with a dietitian nutritionist and a diabetes health educator would be the ideal way of giving you personalized recommendations about diet. I can only scratch the surface by saying that you will want to consume very small amounts of simple sugars, such as fruit juices, sugar-sweetened soft drinks, sweet baked goods and candies. You also want to have no more than modest consumption of processed starches, such as bread, pasta and white rice. When you do consume them, it should be as part of a mixed meal with protein and fat, which slows absorption of the starches that would otherwise be converted rapidly to sugar by the body.
Exercise is just as important as diet. Regular, moderate-intensity exercise helps the body use dietary carbohydrates better, reducing the risk of progression to diabetes. Your exercise goal should be to eventually reach 20-30 minutes a day of moderate exercise. Some people are already way above that, while others may take weeks to safely get to that level of intensity. Neither exercise nor a proper diet are guarantees against developing diabetes, but the two together are powerful.
DEAR DR. ROACH: This is a general question about vaccine reactions. My husband and I both recently had influenza vaccines and shingles second vaccine. Neither of us had a reaction other than a red spot where the injections were done. Does this mean that they weren’t effective? We’re both over 75 and wonder how strong our immune systems are. Should there have been some reaction? — J.D.
ANSWER: Both the flu vaccine and the shingles vaccine are effective at reducing risk of developing their respective diseases, although neither of them is perfect. Last year, the flu vaccine was about 45% effective overall, while Shingrix (the new two-shot vaccine) has greater than 90% effectiveness in protecting against shingles, even in people in their 70s.
A vaccine reaction within the first 24 hours often relates to the body’s response to the preservatives and stabilizers in the vaccine. A lack of reaction to the vaccine does not mean that your body isn’t responding to the key portion of the vaccine, the part that gives immunity to the virus. You should still be protected.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.
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